Page 102 DATE: December 23, 1931
NAME of DECEASED: Mary W. Scott (sic, should be May W. Scott)
SEX: F COLOR: White
CHARGE TO: ORDER GIVEN BY:
Date of Funeral: Dec. 26, 1931 Place of Death: hospital - Des Moines
Funeral Services at home in Kellerton
Time of Funeral Services: 2 P. M. Clergyman: Rev. Voss
Certifying Physician: Dr. Ray His Residence: Des Moines
Cause of Death: Perforated appendix Date of Death: Dec. 23, 1931
Occupation of the Deceased: Homemaker
Single, Married, Divorced: Married Religion: Protestant
Aged: 55 years, 1 months, 15 days Birth Place:
Father: Birth Place:
Maiden Name of Mother: Birth Place:
Name of Husband:
Informant: Address:
Size and Style of Casket or Coffin: State, Gray
Manufactured by: Grant City
Interment at Rose Hill, Mt. Ayr Cemetery